Download Suchitra Dalvie - International Consortium for Medical Abortion

Abortion Advocacy:
Yesterday, today and tomorrow
9th March 2012
Bangkok
What we know now:
• Sometimes a law is the last thing that changes,
sometimes it’s the first.
• A good law is necessary but not sufficient to make
abortion safe.
• Availability of and access to services of good quality,
which meet set standards, and adequate numbers of
trained and sympathetic providers, is also necessary.
….. but to make it happen…………..
…a grassroots movement of women working with:
• abortion providers and other medical professionals
• community leaders and groups
• mainstream women’s organisations
• supportive lawyers, parliamentarians
• progressive religious leaders
• Many others........
How is today different from the 1970s, 80s ,90s ?
• The anti-abortion movement is bigger, more
sophisticated in its tactics and a better funded and
more formidable opponent.
• Abortion methods are much safer than they used to
be even ten years ago, and require fewer medical
skills.
• Information technology has made communication
easier
What is the same?
• The need for a critical mass of support:
Until the practice of induced abortion becomes
accepted by society as a legitimate health care service
for women and an accepted choice for women with an
unwanted pregnancy, no matter what their age or
marital status, changes in abortion law and practice are
likely to be slow in coming.
Brazil: survey of ob-gyns
• 4,261 physicians surveyed
• 25% of female physicians and 33% of male physicians had had
an unwanted pregnancy
• 80% of these were aborted.
• Even among those for whom religion was very important,
almost 70% chose abortion when personally faced with
unwanted pregnancy.
• Thus, the closer physicians were to the problem of abortion,
the greater their understanding that there are circumstances
under which abortion is the best or only alternative.
• (Faundes et al)
Medical Abortion Pill
The Game Changer !!
• Where abortion is legal, use of medical abortion is
steadily increasing.
• Drug sources and therefore ‘service provision’ has
changed (drug sellers, internet, wide range of providers)
• Growing number of pharmaceutical companies
producing the two drugs globally (also fake pills).
Even clandestine abortion is changing
• The abortion pill is becoming increasingly
available, including where abortion remains legally
restricted. It is replacing more dangerous
procedures and reducing deaths.
• More hospitals are willing to treat complications
in women who have had unsafe procedures and
more women are seeking treatment.
Increasing role of non-physicians
• France: with medical abortion, physicians confirm
pregnancy and conduct follow-up visit. Nurses do the
rest. (Hassoun 2001)
• South Africa, Viet Nam, USA: nurse practitioners
legally permitted to manage vacuum aspiration and
medical abortions themselves.
(Warriner et al 2006;
Berer 2009)
WHO safe abortion guidance 2003
• Abortion services should be provided at the lowest
appropriate level of the health care system.
• Vacuum aspiration can be provided at primary care
level up to 12 completed weeks of pregnancy and
medical abortion up to 9 completed weeks of
pregnancy.
• Mid-level health workers can be trained to provide
safe, early abortion without compromising safety.
What will tomorrow bring ?